Translocation of endotoxin and acute-phase proteins in malleolar fractures

Background and Objective: Translocation of endotoxins was demonstrated for multiple injury but not for minor trauma such as isolated malleolar fractur es. Major trauma leads to substantial changes in the plasma concentration o f acute-phase proteins. However, isolated malleolar fractures are minor tra uma. The objective of this study was to elucidate the kinetics of endotoxem ia and the ability of plasma to inactivate endotoxin of patients operated o n malleolar fractures and to demonstrate the early time course of the acute -phase proteins C-reactive protein, transferrin, alpha(1)-acid glycoprotein , haptoglobin, and interleukin-6 and to correlate them with the amount of e ndotoxemia. Methods: Thirty patients with malleolar fractures were operated on within 6 hours after injury. Blood was collected immediately after admission and re gularly up to 96 hours after surgery. Results: Preoperative endotoxin plasma levers were increased compared with that of healthy individuals (0.05 +/- 0.017 vs. 0.02 EU/mL). Endotoxemia pe aked 0.5 hours after the surgical procedure at 0.096 +/- 0.03 (p < 0.05 vs, healthy) and decreased to almost normal values after 24 hours. The ability of the plasma to inactivate endotoxin was significantly reduced after the surgical procedure compared with normal subjects (recovery, 0.17 +/- 0.028 EU/mL vs, 0.04 +/- 0.01 EU/mL; p < 0.05). Plasma interleukin-6 peaked 0.5 h ours postoperatively (114 +/- 11 pg/mL, p < 0.05 vs. healthy), decreasing t hereafter, C-Reactive protein peaked at 45 +/- 5 mg/mL (p < 0.05) 48 hours after injury. Transferrin decreased significantly postoperatively (2.41 +/- 0.12 mg/mL vs, pre-OP 2.65 +/- 0.1 mg/mL) and remained on this level for 9 6 hours. Both, alpha(1)-acid glycoprotein and haptoglobin increased postope ratively until day 4 (0.78 +/- 0.06 mg/mL to 1.15 +/- 0.08 mg/mL and 1.51 /- 0.12 mg/mL to 3.24 + 0.22 mg/mL), There was no correlation between endot oxemia and the concentrations of the acute-phase proteins and interleukin-6 . Conclusion: Surgery for malleolar fractures is associated with temporary en dotoxemia and temporary reduced endotoxin inactivation capacity of the plas ma, The injury and the surgical procedure leads to substantial changes in t he plasma concentrations of acute-phase proteins. The relation between endo toxemia and acute-phase response is not dose dependent.